| NPI | 1114074424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NJ 25MP00178100) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: PA MA050641) |
| Enumeration Date | 2007-01-05 |
| Last Update Date | 2020-11-17 |