| NPI | 1023677853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 023230) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NJ 25MP01025700) |
| Enumeration Date | 2019-06-05 |
| Last Update Date | 2026-07-22 |