NPI | 1104212919 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50.004234) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: OH 50.004234) |
Enumeration Date | 2015-04-08 |
Last Update Date | 2015-04-08 |