| NPI | 1306193156 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP00355200) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 016109) |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2012-08-11 |
| Last Update Date | 2024-11-13 |