| NPI | 1619328564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NJ 25MP00506000) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: PA MA058251) |
| 364SE0003X Clinical Nurse Specialist, Emergency (Licence: PA Processing) | |
| 364SM0705X Clinical Nurse Specialist, Medical-Surgical (Licence: PA Processing) | |
| Enumeration Date | 2016-06-22 |
| Last Update Date | 2019-05-08 |