| NPI | 1023288198 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP00187300) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 013280) |
| Enumeration Date | 2008-03-05 |
| Last Update Date | 2015-01-07 |