NPI | 1417279076 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: OH 50.000761RX) |
Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: OH 50.000761) |
Enumeration Date | 2010-02-24 |
Last Update Date | 2019-02-07 |