| NPI | 1457582710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NJ 25mp00145100) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 010626) |
| Enumeration Date | 2009-08-05 |
| Last Update Date | 2009-08-05 |