| NPI | 1447470711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: NJ 25MP00145400) |
| Enumeration Date | 2007-04-27 |
| Last Update Date | 2022-02-08 |