| NPI | 1851860316 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 9583) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL HSE29941) |
| 208D00000X General Practice (Licence: NJ NJDCATEMP-000540) | |
| 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: 4726) | |
| 363A00000X Physician Assistant (Licence: NJ NJDCATEMP-000512) | |
| 363A00000X Physician Assistant (Licence: PR 000201-P.A.) | |
| Enumeration Date | 2018-11-14 |
| Last Update Date | 2023-05-02 |