| NPI | 1356849392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA061445) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NJ 25MP00537800) |
| Enumeration Date | 2018-01-24 |
| Last Update Date | 2021-06-21 |