| NPI | 1669687091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ MP134) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 001671) |
| Enumeration Date | 2007-05-11 |
| Last Update Date | 2017-08-08 |