| NPI | 1558434795 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085-001642) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IL 085-001642) |
| 363A00000X Physician Assistant (Licence: MO 2023019428) | |
| Enumeration Date | 2006-11-16 |
| Last Update Date | 2023-06-21 |