| NPI | 1144211061 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: FL PA 910847) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NJ MP 00070800) |
| Enumeration Date | 2005-10-31 |
| Last Update Date | 2022-04-14 |