| NPI | 1285039636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP00847500) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 018159) |
| Enumeration Date | 2014-10-28 |
| Last Update Date | 2024-07-10 |