NPI | 1700216322 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085004825) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NJ 25MP00586200) |
Enumeration Date | 2013-11-18 |
Last Update Date | 2023-05-24 |