NPI | 1619924156 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NJ 25MP00177100) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NY 009730) |
Enumeration Date | 2006-05-30 |
Last Update Date | 2024-12-17 |