| NPI | 1407901127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: PA MA053274) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NJ 25mp00152300) |
| Enumeration Date | 2007-01-24 |
| Last Update Date | 2021-05-26 |