| NPI | 1942747720 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: IL 238000530) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: IL 238000530) |
| Enumeration Date | 2017-01-31 |
| Last Update Date | 2022-07-21 |