| NPI | 1255578316 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085003671) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: FL PA9104280) |
| Enumeration Date | 2009-01-12 |
| Last Update Date | 2021-10-27 |