| NPI | 1770698789 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085-002639) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 85002639) |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2013-11-21 |