| NPI | 1417996901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NJ mp00056300) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 006115-1) |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2007-07-08 |