| NPI | 1811464381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085-006798) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085006798) |
| Enumeration Date | 2018-11-01 |
| Last Update Date | 2021-09-27 |