| NPI | 1477847879 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 014688) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NJ 25MP00256600) |
| Enumeration Date | 2011-06-02 |
| Last Update Date | 2011-06-02 |