| 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 | 2026-01-14 |