| NPI | 1275520603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9103651) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NJ 25MP00083900) |
| Enumeration Date | 2005-09-30 |
| Last Update Date | 2013-10-08 |