| NPI | 1245306174 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: NY 010650) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: NJ 25MP00143300) |
| Enumeration Date | 2006-11-24 |
| Last Update Date | 2019-09-22 |