| NPI | 1487244414 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP00644800) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2021-01-23 |
| Last Update Date | 2024-09-24 |