| NPI | 1043587298 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP00270400) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: PA MA056676) |
| Enumeration Date | 2011-11-16 |
| Last Update Date | 2023-11-14 |