| NPI | 1316901705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085-001674) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: IL 085-001674) |
| Enumeration Date | 2006-04-13 |
| Last Update Date | 2019-10-09 |