| NPI | 1699910026 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NJ 25MP00448300) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110009427) |
| Enumeration Date | 2008-12-15 |
| Last Update Date | 2024-04-10 |