| NPI | 1427576248 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: OH 50.005832RX) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA MA059501) |
| 363AS0400X Physician Assistant, Surgical (Licence: PA MA059501) | |
| Enumeration Date | 2017-08-31 |
| Last Update Date | 2025-01-31 |