| NPI | 1336922889 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP00806300) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CT 6508) |
| Enumeration Date | 2023-08-17 |
| Last Update Date | 2025-08-11 |