| NPI | 1538347844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: SD 1546) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NJ 25mp00773400) |
| 363AS0400X Physician Assistant, Surgical (Licence: CT 002041) | |
| Enumeration Date | 2008-02-08 |
| Last Update Date | 2024-08-18 |