| NPI | 1659549780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50.003714) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2008-02-11 |
| Last Update Date | 2022-01-25 |