| NPI | 1275269748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NJ 25MP00711900) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 033351) |
| Enumeration Date | 2022-07-27 |
| Last Update Date | 2025-02-19 |