| NPI | 1083040257 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NJ 25MP00424900) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: DC PA030983) |
| Enumeration Date | 2013-09-19 |
| Last Update Date | 2020-10-16 |