| NPI | 1346614831 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP00749700) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA058010) |
| Enumeration Date | 2015-11-20 |
| Last Update Date | 2023-01-12 |