| NPI | 1437987930 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: IL 085011227) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363A00000X Physician Assistant (Licence: IL 085011227) | |
| Enumeration Date | 2024-07-25 |
| Last Update Date | 2025-04-17 |