| NPI | 1649403619 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 013485) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NJ 25MP00226500) |
| Enumeration Date | 2009-08-25 |
| Last Update Date | 2024-04-25 |