| NPI | 1316183338 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 6648) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085003400) |
| Enumeration Date | 2008-12-22 |
| Last Update Date | 2024-02-09 |