| NPI | 1396226247 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50005680RX) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: OR PA198435) |
| Enumeration Date | 2018-08-28 |
| Last Update Date | 2024-04-22 |