NPI | 1790896306 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085002781) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: IL 085002781) |
Enumeration Date | 2006-08-31 |
Last Update Date | 2022-08-02 |