| NPI | 1447277215 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: OH 2255) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OH 2533) |
| Enumeration Date | 2006-07-16 |
| Last Update Date | 2025-09-11 |