| NPI | 1598317232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085008100) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA MA060646) |
| Enumeration Date | 2019-07-12 |
| Last Update Date | 2022-01-25 |