| NPI | 1548031826 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: OH 50.009195RX) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: LA 340625) |
| Enumeration Date | 2024-01-15 |
| Last Update Date | 2025-02-18 |