| NPI | 1609065085 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: WI 3061-23) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: IL 085003078) |
| Enumeration Date | 2007-10-22 |
| Last Update Date | 2020-12-16 |