| NPI | 1487698627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP00039200) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA062830) |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2025-06-18 |