| NPI | 1386300275 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085.008832) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 008831) |
| Enumeration Date | 2021-11-15 |
| Last Update Date | 2023-03-29 |