NPI | 1023293909 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP00133300) |
Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: NJ 25MP00133300) |
Enumeration Date | 2008-01-09 |
Last Update Date | 2008-01-09 |