| NPI | 1548448806 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NJ 25P00681200) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA MA053278) |
| Enumeration Date | 2008-02-08 |
| Last Update Date | 2022-07-13 |