| NPI | 1609315720 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NJ 25MP00427300) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: PA MA058792) |
| Enumeration Date | 2017-02-22 |
| Last Update Date | 2024-08-07 |