| NPI | 1275697534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085-002924) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 1072529) |
| Enumeration Date | 2006-12-21 |
| Last Update Date | 2020-03-13 |