| NPI | 1922480722 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085006510) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MO 1125480) |
| Enumeration Date | 2015-06-29 |
| Last Update Date | 2024-09-23 |