| NPI | 1972562643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085006771) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: WA PA10001576) |
| Enumeration Date | 2006-03-21 |
| Last Update Date | 2023-01-30 |