| NPI | 1619385390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NH 1259) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NJ 25MP00341700) |
| Enumeration Date | 2014-07-25 |
| Last Update Date | 2022-07-21 |