| NPI | 1811294382 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: IL 238.000294) |
| Additional Taxonomies | 246Z00000X Specialist/Technologist, Other (Licence: IL 238.000294) |
| 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: IL 238.000294) | |
| 246ZS0410X Specialist/Technologist, Other, Surgical Technologist (Licence: IL 238.000294) | |
| Enumeration Date | 2011-02-18 |
| Last Update Date | 2018-10-04 |