| NPI | 1457652620 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085010560) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MS PA00140) |
| Enumeration Date | 2010-11-04 |
| Last Update Date | 2024-11-20 |