| NPI | 1457344855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50.001014) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: OH 50.001014RX) |
| Enumeration Date | 2005-08-31 |
| Last Update Date | 2023-11-09 |