| NPI | 1639157399 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: IL 085000534) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: IA 001420) |
| Enumeration Date | 2006-01-04 |
| Last Update Date | 2011-01-06 |