| NPI | 1598310609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NJ 25mp00534000) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 25mp00534000) |
| Enumeration Date | 2019-08-06 |
| Last Update Date | 2020-09-29 |