| NPI | 1871733022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NY 002198-1) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NJ MP00183) |
| Enumeration Date | 2009-03-01 |
| Last Update Date | 2009-03-01 |