| NPI | 1588344923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: OH 50.008142RX) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MD C0010201) |
| Enumeration Date | 2023-07-20 |
| Last Update Date | 2025-11-18 |