| NPI | 1962880864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP00811600) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NH 1104) |
| 363A00000X Physician Assistant (Licence: CA 54022) | |
| Enumeration Date | 2015-05-12 |
| Last Update Date | 2023-12-05 |