| NPI | 1881347045 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9115336) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085.008896) |
| Enumeration Date | 2022-01-28 |
| Last Update Date | 2023-10-25 |