| NPI | 1619328127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP00538500) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: RI PA00895) |
| Enumeration Date | 2016-06-27 |
| Last Update Date | 2023-01-27 |