| NPI | 1952923328 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP00803800) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 025328) |
| Enumeration Date | 2020-05-08 |
| Last Update Date | 2024-07-01 |