| NPI | 1609250273 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50.004316RX) |
| Additional Taxonomies | 207RA0401X Internal Medicine Addiction Medicine (Licence: OH 50.004316RX) |
| 202D00000X (Licence: OH 50.004316RX) | |
| Enumeration Date | 2015-07-14 |
| Last Update Date | 2025-09-17 |