| NPI | 1962448860 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 1571) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: GA 3957) |
| 363AM0700X Physician Assistant, Medical (Licence: TN 1571) | |
| Enumeration Date | 2006-06-21 |
| Last Update Date | 2017-07-27 |