| NPI | 1194125120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50.006748RX) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 50.006748RX) |
| Enumeration Date | 2014-08-27 |
| Last Update Date | 2021-08-20 |