| NPI | 1316637382 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP00925700) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 030386) |
| 363AS0400X Physician Assistant, Surgical | |
| Enumeration Date | 2023-05-11 |
| Last Update Date | 2025-07-14 |