| NPI | 1902374770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NJ 25MP00542100) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 022754) |
| Enumeration Date | 2018-11-09 |
| Last Update Date | 2024-02-13 |