NPI | 1679545750 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP00106100) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA051206) |
Enumeration Date | 2006-02-03 |
Last Update Date | 2019-10-02 |