| NPI | 1386018398 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA058233) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NJ 25MP00384100) |
| Enumeration Date | 2015-11-16 |
| Last Update Date | 2021-03-01 |