| NPI | 1518028356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 1417) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 005097) |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2016-07-27 |