| NPI | 1134294036 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50001843) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WV 00948) |
| Enumeration Date | 2006-11-24 |
| Last Update Date | 2022-09-19 |