| NPI | 1386920197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 003396) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: KY TC057) |
| Enumeration Date | 2011-10-25 |
| Last Update Date | 2013-09-11 |