| NPI | 1881817708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA003392L) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NJ 25MP00070900) |
| Enumeration Date | 2007-04-10 |
| Last Update Date | 2022-02-18 |