| NPI | 1467012211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA064278) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NJ Pending) |
| 363A00000X Physician Assistant (Licence: NJ 25MP00546100) | |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2019-06-14 |
| Last Update Date | 2023-01-05 |