| NPI | 1174863617 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: OH 50.003718RX) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: OR PA208556) |
| Enumeration Date | 2013-02-20 |
| Last Update Date | 2023-11-03 |