NPI | 1225121064 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MD 0003460) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NJ 25MP000308) |
Enumeration Date | 2006-10-02 |
Last Update Date | 2007-07-20 |