NPI | 1831724061 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: IL 085.009628) |
Additional Taxonomies | 363A00000X Physician Assistant |
Enumeration Date | 2020-03-09 |
Last Update Date | 2023-10-31 |