| NPI | 1447279856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 424) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110840851) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2017-02-15 |