| NPI | 1457628539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 1097188) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical |
| Enumeration Date | 2011-11-17 |
| Last Update Date | 2022-01-05 |