NPI | 1659559185 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50.002743RX) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: SC 2976) |
Enumeration Date | 2008-02-06 |
Last Update Date | 2021-11-30 |