NPI | 1104396076 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085-006788) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: WI 4564) |
Enumeration Date | 2018-12-04 |
Last Update Date | 2024-06-06 |