| NPI | 1912007303 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-05385) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085002524) |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2016-07-06 |