NPI | 1578947685 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP00370600) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NY 018747) |
Enumeration Date | 2015-07-17 |
Last Update Date | 2023-04-26 |