NPI | 1265061543 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085.007818) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: IL 085007818) |
Enumeration Date | 2020-04-07 |
Last Update Date | 2024-09-27 |