| NPI | 1003307372 |
|---|---|
| Professional Name | NA NA |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ NJDCATEMP-002299) |
| Additional Taxonomies | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: TX 17-572) |
| Enumeration Date | 2018-05-23 |
| Last Update Date | 2022-11-23 |