| NPI | 1700292851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP00336400) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ 25mp00336400) |
| Enumeration Date | 2014-07-09 |
| Last Update Date | 2021-09-03 |