NPI | 1255321048 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 1037) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: TN PA1037) |
363AS0400X Physician Assistant, Surgical (Licence: TN PA1037) | |
Enumeration Date | 2005-10-24 |
Last Update Date | 2016-09-14 |