| NPI | 1932741717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085.007272) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363AM0700X Physician Assistant Medical (Licence: IL 085.007272) | |
| Enumeration Date | 2019-10-12 |
| Last Update Date | 2023-11-13 |