| NPI | 1427568823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: OR PA201780) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH 50.005323RX) |
| Enumeration Date | 2017-10-11 |
| Last Update Date | 2023-12-09 |