| NPI | 1215601166 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085-008660) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: IL 085.008660) |
| Enumeration Date | 2021-08-04 |
| Last Update Date | 2023-02-06 |