| NPI | 1023531209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP00662400) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 020975-1) |
| Enumeration Date | 2017-07-19 |
| Last Update Date | 2022-04-05 |