| NPI | 1003244641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085.009830) |
| Enumeration Date | 2013-10-16 |
| Last Update Date | 2024-11-08 |