NPI | 1801454376 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP00535600) |
Additional Taxonomies | 363A00000X Physician Assistant |
Enumeration Date | 2019-05-30 |
Last Update Date | 2021-12-22 |