| NPI | 1386913960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50.003455RX) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: OH 50.003455) |
| Enumeration Date | 2011-12-28 |
| Last Update Date | 2025-04-07 |