| NPI | 1023281664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NJ 25MP00194200) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NY 012311) |
| Enumeration Date | 2008-04-03 |
| Last Update Date | 2016-04-18 |