| NPI | 1770263469 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085010340) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: 1209260) |
| 363A00000X Physician Assistant (Licence: MA PA9559) | |
| Enumeration Date | 2023-07-19 |
| Last Update Date | 2024-05-14 |