| NPI | 1194870725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: IL 085-002851) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 70008945) |
| Enumeration Date | 2007-01-24 |
| Last Update Date | 2007-07-08 |