| NPI | 1033156807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: TN PA0000000609) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: TN PA0000000609) |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2024-02-09 |