| NPI | 1154672822 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: IL 085-004453) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: IL 085-004453) |
| Enumeration Date | 2012-09-21 |
| Last Update Date | 2013-04-01 |