| NPI | 1811355274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085005778) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2016-02-01 |
| Last Update Date | 2018-06-11 |