| NPI | 1215563267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5315227400) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: IL 085007755) |
| Enumeration Date | 2020-03-20 |
| Last Update Date | 2022-12-01 |