NPI | 1225275647 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA9508) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: MD C03597) |
363AM0700X Physician Assistant Medical (Licence: NJ 25MP00738600) | |
Enumeration Date | 2009-01-08 |
Last Update Date | 2023-07-17 |