| NPI | 1508207911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA059477) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NJ 25MP00453900) |
| Enumeration Date | 2013-07-13 |
| Last Update Date | 2025-11-30 |