NPI | 1023288198 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP00187300) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 013280) |
Enumeration Date | 2008-03-05 |
Last Update Date | 2015-01-07 |