| NPI | 1639346620 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AR PA-489) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085002816) |
| Enumeration Date | 2008-05-09 |
| Last Update Date | 2025-02-24 |