| NPI | 1669725842 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP00315200) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 016160) |
| Enumeration Date | 2012-10-24 |
| Last Update Date | 2019-10-03 |