| NPI | 1003351115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: IL 085006117) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085006117) |
| Enumeration Date | 2016-12-28 |
| Last Update Date | 2020-04-13 |