| NPI | 1881701365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MA PA6897) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085-002461) |
| 363A00000X Physician Assistant (Licence: VA 0110007542) | |
| Enumeration Date | 2006-08-23 |
| Last Update Date | 2025-12-23 |