| NPI | 1003197237 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50.003354) |
| Additional Taxonomies | 146D00000X Personal Emergency Response Attendant |
| Enumeration Date | 2011-09-01 |
| Last Update Date | 2017-05-24 |