NPI | 1629441696 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NJ 25MP00518300) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA MA058011) |
363AM0700X Physician Assistant, Medical (Licence: PA OA003706) | |
Enumeration Date | 2015-11-12 |
Last Update Date | 2023-06-29 |