| NPI | 1225652100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NJ 25MP00646000) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-06-05 |
| Last Update Date | 2023-08-29 |