| NPI | 1821371360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP00281800) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA055156) |
| 363A00000X Physician Assistant (Licence: PA OA002732) | |
| Enumeration Date | 2011-09-21 |
| Last Update Date | 2012-03-30 |