| NPI | 1336336361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: AZ 3715) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NJ 25MP00273700) |
| 363AS0400X Physician Assistant, Surgical (Licence: NJ 25MP00273700) | |
| Enumeration Date | 2007-10-03 |
| Last Update Date | 2024-04-11 |