| NPI | 1316343296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: PA MA057239) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: IL 085006546) |
| Enumeration Date | 2014-11-05 |
| Last Update Date | 2024-09-18 |