| NPI | 1922469410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA058140) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NJ 25MP00743200) |
| Enumeration Date | 2016-03-11 |
| Last Update Date | 2023-06-26 |