| NPI | 1639626849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085007677) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 5079-23) |
| Enumeration Date | 2016-09-06 |
| Last Update Date | 2025-02-28 |