NPI | 1750948436 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085007152) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: 1163429) |
Enumeration Date | 2019-05-28 |
Last Update Date | 2021-07-30 |