| NPI | 1063927812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NJ 25MP00459800) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2017-12-01 |
| Last Update Date | 2023-06-05 |