| NPI | 1174918809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 1174918809) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: VA 0110008240) |
| 363AS0400X Physician Assistant, Surgical (Licence: PA MA059753) | |
| Enumeration Date | 2015-03-31 |
| Last Update Date | 2025-01-20 |