NPI | 1649385972 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA051218) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH 50. 001827) |
Enumeration Date | 2006-08-19 |
Last Update Date | 2013-07-16 |