NPI | 1922510528 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP00454200) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NJ 25MP00454200) |
Enumeration Date | 2017-11-04 |
Last Update Date | 2020-06-15 |