| NPI | 1255648242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP00244600) |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: PA P126531) |
| 363AM0700X Physician Assistant, Medical (Licence: PA MA054688) | |
| Enumeration Date | 2010-09-12 |
| Last Update Date | 2020-05-20 |