| NPI | 1881379535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA064519) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NJ 25MP00785400) |
| Enumeration Date | 2023-06-20 |
| Last Update Date | 2024-11-07 |