| NPI | 1932913118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP00911000) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NJ 25MP00911000) |
| Enumeration Date | 2025-02-06 |
| Last Update Date | 2025-10-27 |