| NPI | 1912410135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA OA005337) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085006444) |
| 363A00000X Physician Assistant (Licence: PA MA061260) | |
| Enumeration Date | 2017-11-09 |
| Last Update Date | 2021-07-05 |