| NPI | 1013310291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 2617) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 10091) |
| Enumeration Date | 2014-10-02 |
| Last Update Date | 2025-08-05 |