| NPI | 1730207432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA001128L) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: DE C5-0000309) |
| 363A00000X Physician Assistant (Licence: NJ 25MP00081500) | |
| Enumeration Date | 2007-03-27 |
| Last Update Date | 2013-02-05 |