| NPI | 1386196590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085006711) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA058746) |
| Enumeration Date | 2016-11-04 |
| Last Update Date | 2022-01-17 |