NPI | 1629653639 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: OH 50.00896RX) |
Enumeration Date | 2021-03-11 |
Last Update Date | 2024-09-13 |