| NPI | 1437595782 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9110958) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA MA056118) |
| 363AM0700X Physician Assistant, Medical (Licence: OH 50.003899) | |
| Enumeration Date | 2013-05-14 |
| Last Update Date | 2023-04-28 |