| NPI | 1942455050 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP00697100) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 019610) |
| 363A00000X Physician Assistant (Licence: PA OA004892) | |
| 363A00000X Physician Assistant (Licence: RI PA01294) | |
| 363A00000X Physician Assistant (Licence: PA MA053703) | |
| Enumeration Date | 2008-11-18 |
| Last Update Date | 2022-07-01 |