| NPI | 1467961060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NJ 25MP00849900) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: NJ 40QB00332300) |
| 363A00000X Physician Assistant (Licence: NJ 25MP00849900) | |
| Enumeration Date | 2017-09-26 |
| Last Update Date | 2024-05-30 |