| NPI | 1770953267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP00626100) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 617742-1) |
| 163W00000X Registered Nurse (Licence: CA 811691) | |
| 363A00000X Physician Assistant (Licence: NY 023398) | |
| Enumeration Date | 2015-09-28 |
| Last Update Date | 2025-03-27 |