| NPI | 1720218050 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 1728) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TN 1728) |
| Enumeration Date | 2009-07-21 |
| Last Update Date | 2021-12-29 |