| NPI | 1194184911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085.007003) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NV PA1713) |
| Enumeration Date | 2016-02-22 |
| Last Update Date | 2019-06-17 |