| NPI | 1235528720 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50.007899) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NV PA1592) |
| 363A00000X Physician Assistant (Licence: CA PA60613) | |
| Enumeration Date | 2015-01-21 |
| Last Update Date | 2024-10-30 |