NPI | 1437609377 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 8619) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: IL 085.005958) |
Enumeration Date | 2016-10-04 |
Last Update Date | 2022-05-31 |