| NPI | 1992051478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-07298) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085004374) |
| Enumeration Date | 2012-08-02 |
| Last Update Date | 2022-01-13 |