| NPI | 1083044051 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NJ 25mp00320000) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA MA056513) |
| Enumeration Date | 2013-11-12 |
| Last Update Date | 2014-07-10 |