| NPI | 1093889289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50002540) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601004930) |
| Enumeration Date | 2006-11-20 |
| Last Update Date | 2012-08-15 |