| NPI | 1588754493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 013160) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NJ 25MP00168600) |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2010-04-21 |