| NPI | 1205849981 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NY 019675-1) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NJ 25MP00163400) |
| Enumeration Date | 2006-08-14 |
| Last Update Date | 2023-02-08 |