NPI | 1104813849 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085002508) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: IL 085002508) |
Enumeration Date | 2005-09-27 |
Last Update Date | 2023-07-28 |