| NPI | 1295143337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: NJ 25MP00340000) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NJ 25MP00340000) |
| Enumeration Date | 2014-07-31 |
| Last Update Date | 2022-07-11 |