| NPI | 1740685049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP00343000) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 017784) |
| 363A00000X Physician Assistant (Licence: PA MA057007) | |
| Enumeration Date | 2014-10-29 |
| Last Update Date | 2019-08-30 |