| NPI | 1740394048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NJ MP00187000) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 008674-1) |
| 363AM0700X Physician Assistant, Medical (Licence: NY 008674-1) | |
| 363AS0400X Physician Assistant, Surgical (Licence: NY 008674-1) | |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2022-04-03 |