NPI | 1508889643 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-02781) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NJ 25MP00078500) |
Enumeration Date | 2006-07-26 |
Last Update Date | 2011-06-14 |