NPI | 1760467294 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP00016400) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 25MP00016400) |
363A00000X Physician Assistant (Licence: MD C0002239) | |
Enumeration Date | 2005-12-07 |
Last Update Date | 2025-04-07 |