| NPI | 1215405584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP00798200) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01792700) |
| Enumeration Date | 2018-11-05 |
| Last Update Date | 2023-07-20 |