NPI | 1386913960 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50.003455) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: OH 50.003455) |
Enumeration Date | 2011-12-28 |
Last Update Date | 2014-02-27 |