| NPI | 1285482190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IA 136890) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085012117) |
| Enumeration Date | 2024-05-07 |
| Last Update Date | 2026-07-16 |