| NPI | 1063867950 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 3033) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 3033) |
| 363AM0700X Physician Assistant, Medical (Licence: TN 3033) | |
| Enumeration Date | 2016-04-28 |
| Last Update Date | 2021-08-04 |