| NPI | 1942653944 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP00445900) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9119808) |
| Enumeration Date | 2016-07-14 |
| Last Update Date | 2025-11-18 |