| NPI | 1982297180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 4477) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110008873) |
| 363AM0700X Physician Assistant, Medical (Licence: TN 4477) | |
| 363AM0700X Physician Assistant, Medical (Licence: VA 0110008873) | |
| Enumeration Date | 2021-02-18 |
| Last Update Date | 2024-03-19 |