| NPI | 1043253149 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50.006426RX) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 004685) |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2023-12-15 |