| NPI | 1841572518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 9667) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AL PA1003) |
| 363A00000X Physician Assistant (Licence: TN 2015) | |
| Enumeration Date | 2011-09-19 |
| Last Update Date | 2020-07-06 |