| NPI | 1881701472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 6113) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NJ 25MP00081700) |
| Enumeration Date | 2006-08-23 |
| Last Update Date | 2022-06-10 |