| NPI | 1144749359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP00493000) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 021184-1) |
| Enumeration Date | 2017-09-19 |
| Last Update Date | 2020-01-30 |