| NPI | 1982935987 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NJ 25MP00231000) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NJ 25MP00231000) |
| 363AS0400X Physician Assistant, Surgical (Licence: MD C05070) | |
| Enumeration Date | 2010-01-15 |
| Last Update Date | 2017-02-14 |