| NPI | 1427105360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NJ 25MP00205600) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NY 010392) |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2011-06-28 |