| NPI | 1518010537 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 1448) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 4958) |
| Enumeration Date | 2007-01-21 |
| Last Update Date | 2017-03-28 |