| NPI | 1396171336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50.003874) |
| Additional Taxonomies | 146D00000X Personal Emergency Response Attendant (Licence: OH 50003874) |
| Enumeration Date | 2013-09-23 |
| Last Update Date | 2021-01-18 |