| NPI | 1205291184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP00443200) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110007588) |
| Enumeration Date | 2015-12-21 |
| Last Update Date | 2024-08-02 |