NPI | 1679995468 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 34.010950) |
Additional Taxonomies | 363A00000X Physician Assistant |
Enumeration Date | 2014-01-13 |
Last Update Date | 2022-03-15 |