NPI | 1902535594 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085010568) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: IL 085010568) |
Enumeration Date | 2022-06-08 |
Last Update Date | 2024-10-31 |