NPI | 1669783379 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085.005454) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NJ 25MP00235400) |
Enumeration Date | 2010-06-28 |
Last Update Date | 2015-09-14 |