| NPI | 1053948570 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP00568500) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2020-03-25 |
| Last Update Date | 2021-01-15 |