| NPI | 1346464971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP00160500) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA052484) |
| Enumeration Date | 2007-04-13 |
| Last Update Date | 2021-10-11 |