| NPI | 1134129174 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: OH 2046) |
| Enumeration Date | 2005-07-29 |
| Last Update Date | 2009-07-28 |