| NPI | 1255787297 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50004750RX) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2016-05-09 |
| Last Update Date | 2022-01-03 |