| NPI | 1245811165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50.006870RX) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: OH 50.006870) |
| 363A00000X Physician Assistant (Licence: GA 12341) | |
| Enumeration Date | 2021-04-21 |
| Last Update Date | 2024-06-06 |