| NPI | 1548826597 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50.006214RX) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH 50.006214) |
| Enumeration Date | 2019-05-15 |
| Last Update Date | 2021-12-27 |