| NPI | 1114914199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: IL 085002298) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085.002298) |
| 363AM0700X Physician Assistant, Medical (Licence: IL 085-002298) | |
| Enumeration Date | 2005-10-04 |
| Last Update Date | 2025-04-21 |