| NPI | 1689663528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NJ 25MP00691400) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9101332) |
| Enumeration Date | 2005-10-13 |
| Last Update Date | 2022-06-07 |