| NPI | 1366879330 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: IL 238.000377) |
| Additional Taxonomies | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: IL 238.000377) |
| Enumeration Date | 2013-10-04 |
| Last Update Date | 2024-03-19 |