| NPI | 1730398140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25mp00031200) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 011206-1) |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2015-11-11 |