| NPI | 1073584140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN PA63) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 00063) |
| Enumeration Date | 2006-01-27 |
| Last Update Date | 2011-08-04 |