| NPI | 1356300909 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085002345) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IA 001659) |
| Enumeration Date | 2006-03-22 |
| Last Update Date | 2012-05-21 |