| NPI | 1982659884 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP00087000) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA058615) |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2024-11-26 |