| NPI | 1396101374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NJ 041556) |
| Additional Taxonomies | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: NJ 15-760) |
| Enumeration Date | 2016-01-07 |
| Last Update Date | 2021-11-02 |