| NPI | 1477908184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 503004730RX) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH 1135037) |
| Enumeration Date | 2016-05-01 |
| Last Update Date | 2025-11-03 |