NPI | 1194184911 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085.007003) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NV PA1713) |
Enumeration Date | 2016-02-22 |
Last Update Date | 2019-06-17 |