| NPI | 1194117184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: FL 9111731) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL 9111731) |
| 225100000X Physical Therapist (Licence: NJ 40QA01595600) | |
| 363A00000X Physician Assistant | |
| 363A00000X Physician Assistant (Licence: NJ 25MP00494400) | |
| Enumeration Date | 2015-02-27 |
| Last Update Date | 2024-01-26 |