| NPI | 1114914199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085.002298) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: IL 085-002298) |
| Enumeration Date | 2005-10-04 |
| Last Update Date | 2020-10-30 |