| NPI | 1982254876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 8330) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ NJDCATEMP-000692) |
| 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: WI 21-302) | |
| 363A00000X Physician Assistant (Licence: PR 429-P.A.) | |
| 363A00000X Physician Assistant (Licence: NJ NJDCATEMP-000305) | |
| Enumeration Date | 2019-09-12 |
| Last Update Date | 2022-12-13 |