| NPI | 1285840264 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 2279G1100X Respiratory Therapist, Registered, General Care (Licence: NJ 43ZA00065700) |
| 363AS0400X Physician Assistant, Surgical (Licence: NJ 25MP00078700) | |
| 363AS0400X Physician Assistant, Surgical (Licence: FL PA9107169) | |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2023-02-06 |