| NPI | 1194363234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP00740400) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2019-12-19 |
| Last Update Date | 2024-07-19 |