| NPI | 1033766480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA060922) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NJ 25MP00546200) |
| Enumeration Date | 2019-08-21 |
| Last Update Date | 2022-08-03 |