NPI | 1235753559 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: IL 085008548) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085008548) |
Enumeration Date | 2020-06-02 |
Last Update Date | 2022-04-20 |