| NPI | 1619996402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP00193800) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CT 001569) |
| 363AS0400X Physician Assistant, Surgical (Licence: NJ 25MP00193800) | |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2024-06-20 |