| NPI | 1407842305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN PA1177) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: TN PA1177) |
| Enumeration Date | 2005-09-26 |
| Last Update Date | 2018-12-04 |