| NPI | 1841293354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IA 001170) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085-001376) |
| Enumeration Date | 2005-05-31 |
| Last Update Date | 2023-03-23 |