NPI | 1619996402 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP00193800) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: CT 001569) |
363AS0400X Physician Assistant, Surgical (Licence: NJ 25MP00193800) | |
Enumeration Date | 2006-07-19 |
Last Update Date | 2024-06-20 |