NPI | 1548242738 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085002227) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 7396-23) |
Enumeration Date | 2005-11-15 |
Last Update Date | 2023-08-03 |