| NPI | 1568983104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NJ 25MP00436600) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NJ 25MP0043660) |
| 363AS0400X Physician Assistant, Surgical (Licence: NJ 25MP00436600) | |
| Enumeration Date | 2017-07-05 |
| Last Update Date | 2024-04-24 |