| NPI | 1326352006 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NJ 25MP00418000) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 014098-1) |
| Enumeration Date | 2010-08-04 |
| Last Update Date | 2019-07-09 |