| NPI | 1073632022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP00192000) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363AS0400X Physician Assistant Surgical (Licence: PA MA053300) | |
| 363AS0400X Physician Assistant Surgical (Licence: NJ 25MP00192000) | |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2023-10-06 |