| NPI | 1174040539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NJ 25MP00445700) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NJ 25MP00445700) |
| 207X00000X Orthopaedic Surgery (Licence: NJ 25MP00445700) | |
| 363A00000X Physician Assistant (Licence: NY 021217) | |
| Enumeration Date | 2017-08-26 |
| Last Update Date | 2024-05-02 |