| NPI | 1417938408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 207RI0200X Internal Medicine, Infectious Disease (Licence: TN 0000053672) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 207Q00000X Family Medicine (Licence: TN 0000053672) | |
| 207R00000X Internal Medicine (Licence: TN MD53672) | |
| Enumeration Date | 2005-11-08 |
| Last Update Date | 2025-03-20 |