| NPI | 1639492804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085006027) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AL TA1704) |
| 363AS0400X Physician Assistant, Surgical (Licence: AL 695) | |
| Enumeration Date | 2010-03-02 |
| Last Update Date | 2022-02-15 |