NPI | 1245277896 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50.001837) |
Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: OH 50-00-1837) |
Enumeration Date | 2006-06-01 |
Last Update Date | 2023-11-09 |