| NPI | 1922383769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: WI 7612) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: IL 085004186) |
| Enumeration Date | 2011-10-12 |
| Last Update Date | 2024-03-18 |