| NPI | 1184296303 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085008383) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: IL 085.008383) |
| 363A00000X Physician Assistant (Licence: IN 10003556A) | |
| Enumeration Date | 2021-07-15 |
| Last Update Date | 2024-03-25 |