| NPI | 1366415283 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50.002024RX) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363A00000X Physician Assistant (Licence: FL PA9104087) | |
| 363A00000X Physician Assistant (Licence: IN 10002420A) | |
| Enumeration Date | 2006-02-10 |
| Last Update Date | 2025-05-21 |