| NPI | 1982881181 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 2943) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: UT 326942-1206) |
| Enumeration Date | 2008-01-30 |
| Last Update Date | 2022-08-16 |