| NPI | 1407519242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP00858700) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: DE C5-0011903) |
| Enumeration Date | 2021-10-19 |
| Last Update Date | 2024-08-27 |