| NPI | 1437445715 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50.004423) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NC 1098226) |
| Enumeration Date | 2011-06-24 |
| Last Update Date | 2018-05-14 |