| NPI | 1235476755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085009681) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: WI 3644-23) |
| Enumeration Date | 2013-01-04 |
| Last Update Date | 2023-09-08 |