NPI | 1619496619 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085008405) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical |
Enumeration Date | 2017-09-12 |
Last Update Date | 2022-09-21 |