| NPI | 1588967285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NJ 25MA12108600) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 014519) |
| 363AS0400X Physician Assistant, Surgical (Licence: NJ MP2500251700) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-12-19 |
| Last Update Date | 2024-09-28 |