| NPI | 1588611834 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: IL 085002192) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IN 10003828A) |
| Enumeration Date | 2006-05-30 |
| Last Update Date | 2023-06-16 |