| NPI | 1952378994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP00334300) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA052320) |
| Enumeration Date | 2006-03-08 |
| Last Update Date | 2021-01-26 |