| NPI | 1184904567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IA 002217) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085004237) |
| Enumeration Date | 2011-08-17 |
| Last Update Date | 2011-11-14 |