| NPI | 1144399833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NJ 25MP00106800) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NJ MP00106800) |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2021-07-26 |