| NPI | 1598313793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH 50.006161RX) |
| Enumeration Date | 2019-08-30 |
| Last Update Date | 2023-08-23 |