| NPI | 1073983441 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP00518900) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MA059769) |
| Enumeration Date | 2015-09-29 |
| Last Update Date | 2024-08-28 |