| NPI | 1639324197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085-003426) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ 3482) |
| Enumeration Date | 2008-11-25 |
| Last Update Date | 2020-07-06 |