| NPI | 1619526217 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 8276) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ NJDCATEMP-000588) |
| 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: WI 21-308) | |
| 363A00000X Physician Assistant (Licence: RI PA01253) | |
| 363A00000X Physician Assistant (Licence: PR 000430-P.A) | |
| 363A00000X Physician Assistant (Licence: NJ NJDCATEMP-00291) | |
| Enumeration Date | 2019-09-05 |
| Last Update Date | 2022-10-06 |