| NPI | 1750948436 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085007152) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: 1163429) |
| Enumeration Date | 2019-05-28 |
| Last Update Date | 2021-07-30 |