| NPI | 1124564331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP00780400) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: 1134461) |
| Enumeration Date | 2017-01-11 |
| Last Update Date | 2026-07-15 |