| NPI | 1427502467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 4999) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA PA60692660) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: TN 4999) | |
| Enumeration Date | 2016-08-08 |
| Last Update Date | 2022-06-16 |