| NPI | 1033520564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NJ 25MP00332700) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NJ 25MP00332700) |
| Enumeration Date | 2014-05-19 |
| Last Update Date | 2024-04-26 |