| NPI | 1659105559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50.008966RX) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: OH 50.008966RX) |
| Enumeration Date | 2024-09-02 |
| Last Update Date | 2024-11-15 |