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 |