NPI | 1457652620 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085010560) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: MS PA00140) |
Enumeration Date | 2010-11-04 |
Last Update Date | 2024-11-20 |