| NPI | 1598876617 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: IL 85001515) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IL 085001515) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2009-08-03 |