| NPI | 1619911823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA055483) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NJ 25MP0007900) |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2024-01-18 |