| NPI | 1306954987 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: OH 50000968) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 50.000968) |
| Enumeration Date | 2006-08-25 |
| Last Update Date | 2010-06-01 |