| NPI | 1346468238 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NY 000177-1) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: DC 269) |
| 363A00000X Physician Assistant (Licence: NJ 25MP00250100) | |
| Enumeration Date | 2007-04-23 |
| Last Update Date | 2011-01-04 |