| NPI | 1992823579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 21351) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085-002700) |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2019-09-19 |