| NPI | 1285064303 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA6625) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NJ 25MP00367200) |
| 363A00000X Physician Assistant (Licence: PA MA056613) | |
| 363A00000X Physician Assistant (Licence: PA OA003183) | |
| Enumeration Date | 2013-11-26 |
| Last Update Date | 2019-02-06 |