NPI | 1639307903 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50.002909) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH 50002909RX) |
Enumeration Date | 2009-06-25 |
Last Update Date | 2023-03-24 |