| NPI | 1497888259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP00011800) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: DE C5-0000539) |
| Enumeration Date | 2007-03-13 |
| Last Update Date | 2007-07-08 |