| NPI | 1952052516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085008821) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041507196) |
| 163W00000X Registered Nurse (Licence: MD R228462) | |
| Enumeration Date | 2022-01-15 |
| Last Update Date | 2022-03-01 |