| NPI | 1891778254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 85001646) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IL 085-001646) |
| Enumeration Date | 2005-11-21 |
| Last Update Date | 2008-04-24 |