| NPI | 1386799054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085008529) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: GA 2153) |
| Enumeration Date | 2007-01-24 |
| Last Update Date | 2021-09-01 |