| NPI | 1578947685 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP00370600) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NY 018747) |
| Enumeration Date | 2015-07-17 |
| Last Update Date | 2023-04-26 |