| NPI | 1164443735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP00025400) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NJ 25MP00025400) |
| 363AS0400X Physician Assistant, Surgical (Licence: FL PA9102861) | |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2023-01-19 |