| NPI | 1972939080 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NJ 25MP00327100) |
| Enumeration Date | 2013-09-20 |
| Last Update Date | 2024-06-24 |