| NPI | 1235161167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50000230) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 50.000230) |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2010-06-22 |