| NPI | 1962872200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085006089) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA 1128403) |
| Enumeration Date | 2015-09-29 |
| Last Update Date | 2025-12-18 |