| NPI | 1942249511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 312) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TN MW0564333) |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2007-12-04 |