| NPI | 1922189307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-02884) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085000444) |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2022-05-04 |