NPI | 1952651135 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NJ 25MP00792000) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 015721) |
Enumeration Date | 2012-09-14 |
Last Update Date | 2024-03-21 |