| NPI | 1740913847 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085010498) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 8072-23) |
| Enumeration Date | 2022-07-06 |
| Last Update Date | 2024-09-26 |