| NPI | 1588746721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP00305600) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CT 3763) |
| Enumeration Date | 2006-10-19 |
| Last Update Date | 2022-08-03 |