| NPI | 1740263284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP00438800) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 004964) |
| Enumeration Date | 2005-11-29 |
| Last Update Date | 2022-04-22 |