| NPI | 1619092095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: IL 085002545) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: IL 085-002545) |
| Enumeration Date | 2007-03-21 |
| Last Update Date | 2023-01-23 |