| NPI | 1326041781 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110008519) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NJ 25MP00139100) |
| Enumeration Date | 2005-05-31 |
| Last Update Date | 2023-12-15 |