| NPI | 1336994029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 032186) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NJ 25MP00981700) |
| Enumeration Date | 2024-04-17 |
| Last Update Date | 2026-02-12 |