| NPI | 1508956202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NJ 25MP00065900) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA MA051149) |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2023-12-22 |