| NPI | 1942525910 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085-003711) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085003711) |
| 363AM0700X Physician Assistant, Medical (Licence: IL 085003711) | |
| Enumeration Date | 2010-04-02 |
| Last Update Date | 2020-05-13 |