| NPI | 1285946020 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: NJ NJDCATEMP-006339) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PR 332-PA) |
| 363AM0700X Physician Assistant, Medical (Licence: PR 332-PA) | |
| Enumeration Date | 2010-07-09 |
| Last Update Date | 2020-11-29 |