| NPI | 1215084850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-0829) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer |
| 363A00000X Physician Assistant (Licence: OH 50.004925RX) | |
| Enumeration Date | 2007-01-05 |
| Last Update Date | 2018-08-08 |