| NPI | 1437573698 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: OH 50.006411RX) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: VA 0110-004503) |
| Enumeration Date | 2014-02-08 |
| Last Update Date | 2020-05-27 |