| NPI | 1306170162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: IL 085-003650) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: IL 085-003650) |
| Enumeration Date | 2009-09-28 |
| Last Update Date | 2021-07-12 |