NPI | 1639626393 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP00408300) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical |
Enumeration Date | 2016-09-09 |
Last Update Date | 2021-05-25 |