| NPI | 1366653503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NJ 25MP00394500) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: PA MA052723) |
| Enumeration Date | 2007-05-26 |
| Last Update Date | 2024-06-25 |