| NPI | 1518123710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NJ 25MP0019900) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA MA055456) |
| Enumeration Date | 2008-08-06 |
| Last Update Date | 2018-03-17 |