| NPI | 1326095480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ MP00097400) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA051568) |
| Enumeration Date | 2006-05-27 |
| Last Update Date | 2024-01-15 |