| NPI | 1275781981 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA053552) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA20021) |
| 363A00000X Physician Assistant (Licence: OH 50.002820) | |
| Enumeration Date | 2008-09-05 |
| Last Update Date | 2021-04-16 |