NPI | 1437297066 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: TN PA2178) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MI 5601005111) |
Enumeration Date | 2007-02-03 |
Last Update Date | 2022-03-22 |