| NPI | 1851565063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP00228100) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NY 012456) |
| Enumeration Date | 2008-04-17 |
| Last Update Date | 2010-03-31 |