| NPI | 1639442452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP00696300) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 028167) |
| 363A00000X Physician Assistant (Licence: OH 50.007496) | |
| 363A00000X Physician Assistant (Licence: MA PA9449) | |
| 363AM0700X Physician Assistant, Medical (Licence: NC 0010-03382) | |
| Enumeration Date | 2012-02-10 |
| Last Update Date | 2023-11-07 |