NPI | 1285368175 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA063789) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NJ 25MP00794500) |
Enumeration Date | 2022-07-15 |
Last Update Date | 2025-07-22 |