| NPI | 1467059808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50.006854RX) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH PENDING) |
| Enumeration Date | 2020-10-08 |
| Last Update Date | 2025-03-20 |