NPI | 1164192134 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085010432) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: IN 10003402A) |
Enumeration Date | 2021-09-20 |
Last Update Date | 2024-10-08 |