| NPI | 1992080048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085-009217) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: VA 0110-003690) |
| Enumeration Date | 2011-10-19 |
| Last Update Date | 2023-11-03 |