| NPI | 1457068405 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085009318) |
| Enumeration Date | 2022-10-31 |
| Last Update Date | 2025-08-18 |