| NPI | 1336891118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NJ 25MP00708300) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: DE C5-0011712) |
| 363AM0700X Physician Assistant, Medical (Licence: PA MA063427) | |
| Enumeration Date | 2022-01-22 |
| Last Update Date | 2022-07-27 |