| NPI | 1467740118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP00911900) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 014835-1) |
| Enumeration Date | 2011-07-15 |
| Last Update Date | 2026-04-15 |