NPI | 1992016661 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085.003829) |
Enumeration Date | 2010-06-28 |
Last Update Date | 2019-10-21 |