| NPI | 1245220243 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085003706) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: IL 085003706) |
| Enumeration Date | 2005-10-21 |
| Last Update Date | 2021-06-03 |