| NPI | 1427146539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 61322) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: TN PA0000001445) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2022-09-13 |