| NPI | 1699317677 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA061195) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NJ 25MP00551000) |
| Enumeration Date | 2019-10-11 |
| Last Update Date | 2025-03-31 |