| NPI | 1629600028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 50.006352RX) |
| 363A00000X Physician Assistant (Licence: OH 50.006352RX) | |
| Enumeration Date | 2020-02-04 |
| Last Update Date | 2021-04-05 |