| NPI | 1831594944 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NJ 25MP00417600) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NJ 25MP00417600) |
| 363AM0700X Physician Assistant, Medical (Licence: PA MA059672) | |
| Enumeration Date | 2014-10-31 |
| Last Update Date | 2023-09-20 |