| NPI | 1306198239 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50.003949RX) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA055732) |
| Enumeration Date | 2012-10-02 |
| Last Update Date | 2025-02-21 |