| NPI | 1396100749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: OH 50.007297) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: PA MA058003) |
| 363AS0400X Physician Assistant, Surgical (Licence: PA OA003697) | |
| Enumeration Date | 2015-12-29 |
| Last Update Date | 2022-12-06 |