| NPI | 1609873231 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP00107900) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NJ 25mp00107900) |
| Enumeration Date | 2005-06-28 |
| Last Update Date | 2010-12-15 |