| NPI | 1285209015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NJ 25MP00632600) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2021-05-24 |
| Last Update Date | 2021-09-30 |