NPI | 1790068799 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25mp00267600) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NY 015387-1) |
Enumeration Date | 2011-09-26 |
Last Update Date | 2012-12-26 |