| NPI | 1699765768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC 2470) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 1066142) |
| Enumeration Date | 2005-10-28 |
| Last Update Date | 2018-10-24 |