| NPI | 1932381696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA06264) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085-003153) |
| Enumeration Date | 2007-12-04 |
| Last Update Date | 2013-08-20 |