| NPI | 1932368552 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 1654) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 3566) |
| Enumeration Date | 2008-06-09 |
| Last Update Date | 2022-09-05 |