| NPI | 1851920524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PR 000295-PA) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL HSE30491) |
| 363A00000X Physician Assistant (Licence: NJ NJDCATEMP-000594) | |
| Enumeration Date | 2020-04-05 |
| Last Update Date | 2023-01-25 |