| NPI | 1487173506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: OH 50005761RX) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: PA MA059140) |
| Enumeration Date | 2017-09-11 |
| Last Update Date | 2019-07-03 |