| NPI | 1740486075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NJ 25MP00158700) |
| Additional Taxonomies | 242T00000X Perfusionist (Licence: NJ 25MI00001800) |
| 363A00000X Physician Assistant (Licence: NY 011394) | |
| Enumeration Date | 2007-06-24 |
| Last Update Date | 2008-10-15 |