| NPI | 1396053617 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NJ 25MP00264400) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 014271) |
| Enumeration Date | 2010-09-21 |
| Last Update Date | 2025-08-21 |