| NPI | 1447221932 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: ID PA-1083) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085-001388) |
| Enumeration Date | 2006-02-01 |
| Last Update Date | 2021-06-15 |