| NPI | 1023111283 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: IL 085-002779) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085-002779) |
| Enumeration Date | 2006-09-06 |
| Last Update Date | 2014-06-23 |