NPI | 1053369546 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085001321) |
Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: IN 10004104A) |
Enumeration Date | 2006-05-05 |
Last Update Date | 2025-02-10 |