NPI | 1609065085 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: WI 3061-23) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: IL 085003078) |
Enumeration Date | 2007-10-22 |
Last Update Date | 2020-12-16 |