| NPI | 1346568060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50003052) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601005708) |
| Enumeration Date | 2010-05-05 |
| Last Update Date | 2022-10-06 |