| NPI | 1558422766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NY 011450-1) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NJ 2SMP00172500) |
| 363AS0400X Physician Assistant, Surgical (Licence: NJ 25MP00172500) | |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2019-05-21 |