| NPI | 1972577054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: NJ 25MP00276900) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: DE C50000225) |
| Enumeration Date | 2006-02-15 |
| Last Update Date | 2013-03-07 |