| NPI | 1215983879 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50002301) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9106675) |
| Enumeration Date | 2006-05-25 |
| Last Update Date | 2018-08-23 |