| NPI | 1306498068 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN PA3905) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 3905) |
| Enumeration Date | 2019-07-12 |
| Last Update Date | 2020-11-09 |