NPI | 1649244336 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085003674) |
Additional Taxonomies | 364SE0003X Clinical Nurse Specialist, Emergency (Licence: CA PA16498) |
Enumeration Date | 2006-02-17 |
Last Update Date | 2010-02-10 |