NPI | 1053408591 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 2723) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: SC 1140) |
Enumeration Date | 2006-10-06 |
Last Update Date | 2023-03-07 |