| NPI | 1235310186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NJ 25MP00452600) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA MA000693L) |
| Enumeration Date | 2007-11-20 |
| Last Update Date | 2018-06-04 |