| NPI | 1396096236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP00294500) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 015918) |
| Enumeration Date | 2012-10-01 |
| Last Update Date | 2016-06-03 |