| NPI | 1508870924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP00162100) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NY 011393) |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2018-03-17 |