| NPI | 1598295883 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 023465) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NJ 25MP00434900) |
| 363AS0400X Physician Assistant, Surgical (Licence: NJ 25MP00434900) | |
| Enumeration Date | 2017-06-19 |
| Last Update Date | 2020-08-22 |