| NPI | 1194188383 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085006073) |
| Additional Taxonomies | 208800000X Urology (Licence: IL 085006073) |
| 208800000X Urology (Licence: TX PA10406) | |
| 363AS0400X Physician Assistant, Surgical | |
| Enumeration Date | 2016-04-04 |
| Last Update Date | 2023-08-02 |