| NPI | 1699919118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085-005525) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 180-004151) |
| Enumeration Date | 2009-04-28 |
| Last Update Date | 2015-11-17 |