| NPI | 1225094709 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY PA293) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TN 863) |
| 207P00000X Emergency Medicine (Licence: TN 863) | |
| Enumeration Date | 2006-04-25 |
| Last Update Date | 2013-12-02 |