| NPI | 1902992092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA002993L) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NJ 25mp00085900) |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2024-12-17 |