| NPI | 1912939505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NJ 25MP00129900) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: MA 181) |
| 363AS0400X Physician Assistant, Surgical (Licence: NH 0591) | |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2007-07-08 |