| NPI | 1407881238 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN PA737) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA 63804) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2024-01-17 |