| NPI | 1144800624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP00612300) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2021-04-09 |
| Last Update Date | 2025-06-30 |