NPI | 1265572424 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP00510800) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 011093-1) |
Enumeration Date | 2007-02-07 |
Last Update Date | 2024-11-04 |