| NPI | 1841869252 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA67459) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085008366) |
| Enumeration Date | 2021-06-21 |
| Last Update Date | 2025-12-11 |