| NPI | 1881844785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 1082457) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA08381) |
| Enumeration Date | 2008-09-26 |
| Last Update Date | 2013-07-17 |