| NPI | 1245654797 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 019211) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NJ 25MP00329700) |
| Enumeration Date | 2014-02-04 |
| Last Update Date | 2024-11-07 |