| NPI | 1457823999 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP00808000) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2018-12-21 |
| Last Update Date | 2024-01-10 |