| NPI | 1417574427 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 027642) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH 50.006470) |
| Enumeration Date | 2020-06-25 |
| Last Update Date | 2024-02-09 |