| NPI | 1285662098 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50.000053) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 002196) |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2021-01-08 |