| NPI | 1285158147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP00443600) |
| Additional Taxonomies | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: NJ 25MP00443600) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NJ 25MP00443600) | |
| Enumeration Date | 2017-08-01 |
| Last Update Date | 2025-05-12 |