| NPI | 1942565528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP00283900) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA055388) |
| Enumeration Date | 2012-07-10 |
| Last Update Date | 2012-07-10 |