| NPI | 1164664561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: OH 50-003327) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: GA 1857) |
| Enumeration Date | 2009-03-31 |
| Last Update Date | 2021-01-13 |