NPI | 1518684513 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: PR PA1242) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NJ 049629) |
163W00000X Registered Nurse (Licence: FL 9574670) | |
246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: WI 22662) | |
Enumeration Date | 2022-10-20 |
Last Update Date | 2022-10-21 |