| NPI | 1194287490 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP00522300) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2019-04-04 |
| Last Update Date | 2025-02-07 |