| NPI | 1891114278 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085.006776) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA 51486) |
| Enumeration Date | 2014-04-14 |
| Last Update Date | 2018-10-25 |