| NPI | 1033319843 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP00158900) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA051581) |
| 363AS0400X Physician Assistant, Surgical (Licence: NJ 25MP00158900) | |
| Enumeration Date | 2007-07-19 |
| Last Update Date | 2021-04-26 |