| NPI | 1548458375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: TN 1546) |
| Enumeration Date | 2007-10-05 |
| Last Update Date | 2015-05-27 |