| NPI | 1902181597 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP00271400) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 016359-1) |
| 363A00000X Physician Assistant (Licence: FL PA9112825) | |
| Enumeration Date | 2011-10-15 |
| Last Update Date | 2020-03-24 |