| NPI | 1700323490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP00620000) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: RI PA00933) |
| Enumeration Date | 2017-01-19 |
| Last Update Date | 2024-04-24 |