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 |