| NPI | 1699742304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP00375500) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 05641) |
| Enumeration Date | 2006-03-01 |
| Last Update Date | 2022-10-07 |