| NPI | 1831743889 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25mp00548900) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2019-07-29 |
| Last Update Date | 2021-02-03 |