| NPI | 1073684486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NJ 25MP00291500) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 005901) |
| Enumeration Date | 2006-11-10 |
| Last Update Date | 2023-01-26 |