| NPI | 1982204939 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP00586300) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 208100000X Physical Medicine & Rehabilitation (Licence: NJ 25MP00586300) | |
| Enumeration Date | 2020-10-29 |
| Last Update Date | 2024-04-14 |