| NPI | 1215287602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NJ 25MP00627600) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NY 015909) |
| Enumeration Date | 2012-09-13 |
| Last Update Date | 2024-11-13 |