NPI | 1417996901 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NJ mp00056300) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 006115-1) |
Enumeration Date | 2006-06-06 |
Last Update Date | 2007-07-08 |