| NPI | 1528434388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NJ 25MP00371800) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 018887) |
| Enumeration Date | 2015-08-17 |
| Last Update Date | 2026-05-07 |