NPI | 1013955616 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50.001928RX) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: IN 10000630A) |
Enumeration Date | 2006-06-04 |
Last Update Date | 2023-03-30 |