| NPI | 1376347328 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP00916500) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 033479) |
| Enumeration Date | 2025-04-01 |
| Last Update Date | 2025-09-06 |