NPI | 1902335995 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA059112) |
Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: PA pending) |
363A00000X Physician Assistant (Licence: NJ 25MP00465000) | |
Enumeration Date | 2017-06-05 |
Last Update Date | 2023-03-17 |