| NPI | 1992016661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085.003829) |
| Enumeration Date | 2010-06-28 |
| Last Update Date | 2019-10-21 |