| NPI | 1568575819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NJ MP00179200) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 006685) |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2008-07-22 |