| NPI | 1144694373 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP00695000) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA058016) |
| Enumeration Date | 2015-11-27 |
| Last Update Date | 2025-02-03 |