NPI | 1043340797 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50.002057RX) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH 2057) |
Enumeration Date | 2007-03-06 |
Last Update Date | 2018-04-05 |