| NPI | 1295065373 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: OH 50.003900RX) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MI 5601005525) |
| Enumeration Date | 2010-01-12 |
| Last Update Date | 2025-11-10 |