| NPI | 1598956633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: OH 50.002628) |
| Enumeration Date | 2007-08-05 |
| Last Update Date | 2021-01-13 |