| NPI | 1821484460 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP00395100) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NY 018353) |
| Enumeration Date | 2015-04-10 |
| Last Update Date | 2021-05-26 |