| NPI | 1174530828 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP00153200) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 010725) |
| Enumeration Date | 2006-08-02 |
| Last Update Date | 2007-07-08 |