| NPI | 1447538574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IA 086315) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085004029) |
| 363AS0400X Physician Assistant, Surgical (Licence: IL 085004029) | |
| 363AS0400X Physician Assistant, Surgical (Licence: IA 086315) | |
| Enumeration Date | 2011-07-22 |
| Last Update Date | 2017-05-09 |