NPI | 1497016968 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 007725) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085.004358) |
Enumeration Date | 2012-05-31 |
Last Update Date | 2015-09-24 |