| NPI | 1528737376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50.007162RX) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 50.007162RX) |
| Enumeration Date | 2021-09-07 |
| Last Update Date | 2023-04-06 |