| NPI | 1235326059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TN PA0000001531) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TN 1531) |
| Enumeration Date | 2007-09-25 |
| Last Update Date | 2017-02-13 |