| NPI | 1073600508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IN 10000874A) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 1632) |
| 363A00000X Physician Assistant (Licence: OH 50.005985RX) | |
| Enumeration Date | 2006-10-06 |
| Last Update Date | 2024-11-06 |