| NPI | 1285183236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP00503700) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL 9109705) |
| 363A00000X Physician Assistant (Licence: PA MA060244) | |
| Enumeration Date | 2016-09-30 |
| Last Update Date | 2023-11-21 |