| NPI | 1730195058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: DE C5-0000718) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363A00000X Physician Assistant (Licence: NJ 25MP001029000) | |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2022-07-21 |