| NPI | 1376948364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP00350700) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 018032) |
| Enumeration Date | 2014-11-03 |
| Last Update Date | 2020-09-04 |