| NPI | 1134586928 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50.004604RX) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA 53180) |
| Enumeration Date | 2016-01-25 |
| Last Update Date | 2017-10-17 |