| NPI | 1538724794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP00531200) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CT 006404) |
| Enumeration Date | 2019-05-03 |
| Last Update Date | 2025-03-10 |