NPI | 1396723011 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NJ 25MP00072000) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NJ 25MP00072000) |
Enumeration Date | 2006-01-03 |
Last Update Date | 2022-02-01 |