| NPI | 1780164863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP00871100) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA060034) |
| Enumeration Date | 2018-08-17 |
| Last Update Date | 2024-09-23 |