| NPI | 1821398363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363A00000X Physician Assistant (Licence: IL 085.004259) | |
| Enumeration Date | 2010-11-01 |
| Last Update Date | 2024-05-23 |