| NPI | 1619924156 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NJ 25MP00177100) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NY 009730) |
| Enumeration Date | 2006-05-30 |
| Last Update Date | 2024-12-17 |