| NPI | 1528185410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: OH 50.003281) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: CT 001760) |
| Enumeration Date | 2007-03-23 |
| Last Update Date | 2025-05-13 |