| NPI | 1578276937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NJ 25MP00802200) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: PA 1190491) |
| Enumeration Date | 2023-01-02 |
| Last Update Date | 2023-10-04 |