| NPI | 1588734586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA052772) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NJ 25MP00172400) |
| 363AM0700X Physician Assistant, Medical (Licence: PA MA052772) | |
| 363AM0700X Physician Assistant, Medical (Licence: NJ 25MP00172400) | |
| Enumeration Date | 2006-11-08 |
| Last Update Date | 2023-03-10 |