| 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 |