NPI | 1780892695 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: FL PA9113366) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9113366) |
363AM0700X Physician Assistant, Medical (Licence: NJ MP000580) | |
Enumeration Date | 2007-05-21 |
Last Update Date | 2023-04-12 |