| NPI | 1992108955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NJ 25MP00751600) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2014-10-06 |
| Last Update Date | 2023-03-27 |