| NPI | 1134483944 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 3006) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH 50003536) |
| Enumeration Date | 2012-06-26 |
| Last Update Date | 2016-08-03 |