NPI | 1639346620 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: AR PA-489) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085002816) |
Enumeration Date | 2008-05-09 |
Last Update Date | 2025-02-24 |