| NPI | 1093268955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP00410200) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 019890) |
| Enumeration Date | 2016-07-27 |
| Last Update Date | 2024-01-24 |