| NPI | 1891073342 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP00256900) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 020421) |
| Enumeration Date | 2011-08-02 |
| Last Update Date | 2017-04-22 |