| NPI | 1386863199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NJ MP850) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: DE C5-0000329) |
| 363AM0700X Physician Assistant, Medical (Licence: PA MA002876L) | |
| 363AM0700X Physician Assistant, Medical (Licence: PA OA000734) | |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2008-07-11 |