| NPI | 1538298062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50.006763) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601001744) |
| Enumeration Date | 2007-03-02 |
| Last Update Date | 2020-12-03 |