| NPI | 1437257763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA050867) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NJ 25MP00117200) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2022-04-05 |