NPI | 1972914935 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MD C05403) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA056843) |
363A00000X Physician Assistant (Licence: NJ 25MP00335400) | |
Enumeration Date | 2014-05-13 |
Last Update Date | 2014-12-17 |