| NPI | 1427449610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 2713) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 10183) |
| Enumeration Date | 2015-02-10 |
| Last Update Date | 2026-03-13 |