| NPI | 1760632822 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085-003330) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IL 085-003330) |
| Enumeration Date | 2008-09-25 |
| Last Update Date | 2016-07-11 |