NPI | 1053997064 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA063522) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NJ 25MP00646800) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2021-03-20 |
Last Update Date | 2025-01-28 |