| NPI | 1366891830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 3404) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MD C06210) |
| Enumeration Date | 2016-06-06 |
| Last Update Date | 2017-12-14 |