| NPI | 1649894114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: IL 085.008441) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2020-06-01 |
| Last Update Date | 2021-12-16 |