| NPI | 1013316603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP00344200) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363AS0400X Physician Assistant, Surgical (Licence: NJ 25MP00344200) | |
| Enumeration Date | 2014-08-19 |
| Last Update Date | 2021-05-17 |