NPI | 1639157399 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: IL 085000534) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: IA 001420) |
Enumeration Date | 2006-01-04 |
Last Update Date | 2011-01-06 |