NPI | 1770115743 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: PR 309-P.A.) |
Additional Taxonomies | 208D00000X General Practice (Licence: NJ NJDCATEMP-011832) |
Enumeration Date | 2020-02-07 |
Last Update Date | 2020-04-17 |