| NPI | 1750055968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP00633100) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA066646) |
| 363AM0700X Physician Assistant, Medical | |
| Enumeration Date | 2021-08-03 |
| Last Update Date | 2025-08-01 |