| NPI | 1609395557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA060300) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NJ 25MP00441700) |
| Enumeration Date | 2017-09-12 |
| Last Update Date | 2019-07-03 |