| NPI | 1396143301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: NJ 25MP00349000) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 018055) |
| Enumeration Date | 2014-12-08 |
| Last Update Date | 2018-05-09 |