| NPI | 1437250305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50.005783RX) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 023072) |
| 363A00000X Physician Assistant (Licence: NJ 25MP00606400) | |
| 363A00000X Physician Assistant (Licence: MI 003873) | |
| 363A00000X Physician Assistant (Licence: IN 10002696A) | |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2025-07-23 |