| NPI | 1285295428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085007286) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA061230) |
| Enumeration Date | 2019-06-27 |
| Last Update Date | 2023-09-20 |