| NPI | 1295061307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP00257700) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 013676) |
| Enumeration Date | 2009-10-23 |
| Last Update Date | 2015-08-03 |