| NPI | 1215435342 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: NJ 25MP00469900) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NJ 25MP00469900) |
| 363A00000X Physician Assistant (Licence: PA OA004383) | |
| 363AM0700X Physician Assistant Medical (Licence: PA MA059609) | |
| Enumeration Date | 2018-01-23 |
| Last Update Date | 2019-10-02 |