| NPI | 1962426551 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 1344) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TN PA1344) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2016-05-03 |