| NPI | 1750355806 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: PA MA050652) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NJ MP000351) |
| Enumeration Date | 2006-02-15 |
| Last Update Date | 2022-07-20 |