NPI | 1790245371 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085.006969) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: IN 10002736A) |
Enumeration Date | 2019-03-21 |
Last Update Date | 2019-07-18 |