| NPI | 1609560143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP00787100) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: NJ 25MP00787100) |
| Enumeration Date | 2023-06-07 |
| Last Update Date | 2025-07-30 |