| NPI | 1013092410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN PA2064) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: 1035413) |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2012-01-24 |