| NPI | 1609248046 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: OH 50.004537) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: PA MA057965) |
| Enumeration Date | 2015-10-26 |
| Last Update Date | 2022-02-17 |