| NPI | 1740214121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA OA000930) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA MA051565) |
| 363A00000X Physician Assistant (Licence: NJ MP12730) | |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2024-11-12 |