| NPI | 1841587540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085007782) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9106041) |
| Enumeration Date | 2011-06-30 |
| Last Update Date | 2022-12-21 |