| NPI | 1831247279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: TN 1206) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: TN PA0000001206) |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2015-01-22 |