| NPI | 1518054634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MD C08891) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TN PA1128) |
| Enumeration Date | 2006-10-09 |
| Last Update Date | 2023-07-05 |