NPI | 1194236273 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP00478300) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA059403) |
Enumeration Date | 2017-10-17 |
Last Update Date | 2021-12-23 |