| NPI | 1871516047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NE 2087) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: IL 85002515) |
| 363AS0400X Physician Assistant, Surgical (Licence: IL 085002515) | |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2023-12-15 |