| NPI | 1871118174 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085009056) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 8117-23) |
| Enumeration Date | 2020-06-11 |
| Last Update Date | 2024-10-28 |