| NPI | 1649802661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085.008485) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: IL 085.008485) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-02-07 |
| Last Update Date | 2021-12-20 |