| NPI | 1699787721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 940) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: TN 940) |
| 207P00000X Emergency Medicine (Licence: TN 940) | |
| Enumeration Date | 2006-08-13 |
| Last Update Date | 2017-02-10 |