NPI | 1871890129 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085003977) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: IN 10001402A) |
Enumeration Date | 2011-02-23 |
Last Update Date | 2022-04-05 |