| NPI | 1588367544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IA 134263) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085011592) |
| Enumeration Date | 2023-03-27 |
| Last Update Date | 2025-10-17 |