| NPI | 1780876920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP00198200) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NY 011947-1) |
| 363AS0400X Physician Assistant, Surgical (Licence: NJ 25MP00198200) | |
| Enumeration Date | 2007-08-12 |
| Last Update Date | 2025-05-14 |