| NPI | 1447671177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50.008952RX) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-04660) |
| Enumeration Date | 2013-12-24 |
| Last Update Date | 2025-03-19 |