| NPI | 1043401953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: NJ 25MA09969200) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: NY 010567) |
| 363AM0700X Physician Assistant Medical (Licence: PA MA052104) | |
| 363AS0400X Physician Assistant Surgical (Licence: NY 010567) | |
| Enumeration Date | 2007-08-06 |
| Last Update Date | 2018-08-07 |