| NPI | 1932188349 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN PA1080) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MS PA00381) |
| Enumeration Date | 2006-01-13 |
| Last Update Date | 2024-04-05 |