| NPI | 1215448568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IN 10002350A) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363A00000X Physician Assistant (Licence: OH 50.009052RX) | |
| Enumeration Date | 2017-10-13 |
| Last Update Date | 2026-09-02 |