| 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 |