| NPI | 1447061890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: IL 085011169) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2025-01-15 |
| Last Update Date | 2025-04-21 |