| NPI | 1477781557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP00218400) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA MA054369) |
| Enumeration Date | 2009-06-26 |
| Last Update Date | 2011-08-04 |