| NPI | 1326525304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085006652) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: ID PA-2280) |
| Enumeration Date | 2018-07-23 |
| Last Update Date | 2025-07-22 |