| NPI | 1184658056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50002463) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: OH 50-002463) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2018-02-26 |