| NPI | 1043781669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50.005930RX) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA MA063071) |
| 363AM0700X Physician Assistant, Medical (Licence: OH 50.005930RX) | |
| Enumeration Date | 2018-12-07 |
| Last Update Date | 2024-01-09 |