| NPI | 1457570129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9117971) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9117971) |
| 363AS0400X Physician Assistant, Surgical (Licence: OH 50 003857) | |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2023-11-10 |