| NPI | 1568059889 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP00665000) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 025711) |
| Enumeration Date | 2020-12-22 |
| Last Update Date | 2023-09-05 |