| NPI | 1407447345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP00713000) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: DE C50011591) |
| 363A00000X Physician Assistant (Licence: PA MA062771) | |
| Enumeration Date | 2021-02-02 |
| Last Update Date | 2024-08-05 |