| NPI | 1255374930 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NJ 25MP00140500) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NY 010232) |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2019-09-20 |