| NPI | 1306478649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA062481) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NJ 25MP00561000) |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2020-02-05 |
| Last Update Date | 2021-06-28 |