| NPI | 1306519335 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085009697) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: DE C5-0011557) |
| Enumeration Date | 2021-07-27 |
| Last Update Date | 2023-09-19 |