| NPI | 1134739857 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: IL 085007736) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: AZ 11903) |
| Enumeration Date | 2020-08-06 |
| Last Update Date | 2026-08-12 |