| NPI | 1316068018 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085-000586) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: IL 085-000586) |
| Enumeration Date | 2007-04-02 |
| Last Update Date | 2021-04-30 |