| NPI | 1114993862 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: OH 50.002776) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363A00000X Physician Assistant (Licence: GA 003226) | |
| Enumeration Date | 2006-02-23 |
| Last Update Date | 2023-04-17 |