| NPI | 1093078446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50.008880RX) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 2956) |
| Enumeration Date | 2012-06-20 |
| Last Update Date | 2024-09-13 |