| NPI | 1548739204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 023287) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NJ 25MP00498600) |
| Enumeration Date | 2018-11-24 |
| Last Update Date | 2023-02-08 |