| NPI | 1013036409 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP00500200) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH 50.002663) |
| 363AM0700X Physician Assistant, Medical (Licence: KY PA982) | |
| 363AM0700X Physician Assistant, Medical (Licence: NY 016798) | |
| 363AS0400X Physician Assistant, Surgical (Licence: OH 50.002663) | |
| Enumeration Date | 2007-03-28 |
| Last Update Date | 2023-05-09 |