| NPI | 1902305709 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NJ 25MP00844500) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: SC 2928) |
| Enumeration Date | 2018-02-07 |
| Last Update Date | 2024-11-01 |