| NPI | 1801435748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NJ 25mp00682200) |
| Enumeration Date | 2019-12-23 |
| Last Update Date | 2026-01-16 |