| NPI | 1982785572 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085.006901) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA04678) |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2019-01-18 |