| NPI | 1649237405 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN PA0000001389) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2006-04-27 |
| Last Update Date | 2010-12-21 |