| NPI | 1013291244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: OH 50.003364RX) |
| Additional Taxonomies | 146D00000X Personal Emergency Response Attendant (Licence: OH 50003364) |
| 146L00000X Emergency Medical Technician, Paramedic (Licence: OH 77390) | |
| Enumeration Date | 2011-10-06 |
| Last Update Date | 2026-01-22 |