| NPI | 1184855926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP0052300) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NH 0898) |
| Enumeration Date | 2009-07-28 |
| Last Update Date | 2024-08-06 |