| NPI | 1942671425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 6629) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085005683) |
| Enumeration Date | 2015-10-09 |
| Last Update Date | 2023-04-28 |