NPI | 1427294826 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NY 005611) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NJ 25MP00077100) |
Enumeration Date | 2009-01-06 |
Last Update Date | 2009-01-06 |