| NPI | 1992324941 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601011654) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085007716) |
| Enumeration Date | 2020-04-10 |
| Last Update Date | 2026-02-13 |