| NPI | 1689010332 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC 3408) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH 004056) |
| Enumeration Date | 2013-05-21 |
| Last Update Date | 2023-08-09 |