| NPI | 1841233483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN PA0000000981) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TN PA000000981) |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2010-02-23 |