| NPI | 1477825651 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085004969) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA 9106409) |
| Enumeration Date | 2012-02-02 |
| Last Update Date | 2014-04-02 |