NPI | 1457991903 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA061390) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NJ 25MP00556700) |
Enumeration Date | 2020-01-13 |
Last Update Date | 2024-05-23 |