| NPI | 1386670776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 52344) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: IL K05891) |
| Enumeration Date | 2006-06-25 |
| Last Update Date | 2022-10-10 |