| NPI | 1629798806 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50.007747RX) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 50.007747RX) |
| 207X00000X Orthopaedic Surgery (Licence: OH 50.007747RX) | |
| Enumeration Date | 2022-08-30 |
| Last Update Date | 2025-01-16 |