| NPI | 1356354666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NJ 25MP000162) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: ND PAC1053) |
| Enumeration Date | 2006-08-15 |
| Last Update Date | 2024-09-30 |