| NPI | 1588643902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085-001668) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: IL 85001668) |
| Enumeration Date | 2006-01-13 |
| Last Update Date | 2010-07-19 |