| NPI | 1871903880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP00357800) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 018366-1) |
| Enumeration Date | 2014-04-29 |
| Last Update Date | 2021-08-04 |