| NPI | 1689817132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP00918100) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 013015) |
| Enumeration Date | 2009-04-14 |
| Last Update Date | 2025-09-04 |