| NPI | 1386701829 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 000001122) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2007-01-03 |
| Last Update Date | 2019-05-01 |