| NPI | 1932623998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP00648400) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA064082) |
| Enumeration Date | 2017-08-01 |
| Last Update Date | 2023-09-06 |