NPI | 1457918450 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MO 2020042060) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NJ 25MP00522100) |
Enumeration Date | 2019-05-24 |
Last Update Date | 2021-09-20 |