NPI | 1679540470 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601005608) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085001941) |
Enumeration Date | 2006-03-01 |
Last Update Date | 2009-11-03 |