| NPI | 1366623381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IN 10001060A) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: OH 50.002707) |
| Enumeration Date | 2007-11-19 |
| Last Update Date | 2019-06-24 |