| NPI | 1548725062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085009454) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: NY 023232) |
| Enumeration Date | 2019-02-08 |
| Last Update Date | 2023-07-26 |