| NPI | 1467858324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: NJ 25MP00351200) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NJ 25MP00351200) |
| Enumeration Date | 2014-11-05 |
| Last Update Date | 2015-02-23 |