| NPI | 1346493012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IN 10001305A) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH 002839) |
| Enumeration Date | 2008-10-28 |
| Last Update Date | 2013-07-31 |