| NPI | 1356468003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 005184) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NJ MP-0213) |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2007-07-08 |