| NPI | 1851538177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 3304) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-04528) |
| Enumeration Date | 2009-01-08 |
| Last Update Date | 2017-10-27 |