| NPI | 1891406674 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP00762000) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ 9533) |
| Enumeration Date | 2022-12-12 |
| Last Update Date | 2023-03-11 |