| NPI | 1992939748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP00220200) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 013255-1) |
| Enumeration Date | 2009-05-07 |
| Last Update Date | 2024-01-29 |