| NPI | 1255730958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP00366800) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NJ 25mp00366800) |
| Enumeration Date | 2014-08-19 |
| Last Update Date | 2024-05-20 |