NPI | 1629177647 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: IL 085.004313) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9104555) |
Enumeration Date | 2006-09-22 |
Last Update Date | 2013-06-28 |