| NPI | 1457991903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA061390) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NJ 25MP00556700) |
| Enumeration Date | 2020-01-13 |
| Last Update Date | 2024-05-23 |