| NPI | 1902992050 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085-002739) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IL 085-002739) |
| 363A00000X Physician Assistant (Licence: FL PA9103859) | |
| 363AM0700X Physician Assistant Medical (Licence: NC 0010-00923) | |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2020-11-11 |