| NPI | 1942247713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: TN PA0000000820) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: TN PA0000000820) |
| 207P00000X Emergency Medicine (Licence: TN 820) | |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2011-03-16 |