| NPI | 1467472084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 755) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 002663) |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2022-07-21 |