| NPI | 1689124802 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: FL PA9111781) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085.006046) |
| Enumeration Date | 2016-10-12 |
| Last Update Date | 2023-08-07 |