| NPI | 1528420049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP00392600) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MD C0009998) |
| Enumeration Date | 2016-03-23 |
| Last Update Date | 2025-07-24 |