| NPI | 1114522943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50.006773RX) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IN APP-000410585) |
| Enumeration Date | 2020-12-01 |
| Last Update Date | 2022-01-25 |