| NPI | 1235878117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NJ 25MP00846100) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: DC PA200001470) |
| 363A00000X Physician Assistant (Licence: NJ 25MP00846100) | |
| 363AM0700X Physician Assistant, Medical (Licence: DC PA200001470) | |
| 363AS0400X Physician Assistant, Surgical (Licence: DC PA200001470) | |
| Enumeration Date | 2022-05-31 |
| Last Update Date | 2024-08-06 |