NPI | 1164737532 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC 5311) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NJ 25MP00240200) |
Enumeration Date | 2010-08-10 |
Last Update Date | 2024-06-26 |