| NPI | 1265757876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP00424100) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 013933) |
| Enumeration Date | 2010-04-07 |
| Last Update Date | 2018-04-03 |