| NPI | 1932683802 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085009366) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 008965) |
| Enumeration Date | 2018-09-18 |
| Last Update Date | 2023-01-06 |