| NPI | 1396723011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NJ 25MP00072000) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NJ 25MP00072000) |
| Enumeration Date | 2006-01-03 |
| Last Update Date | 2022-02-01 |