| NPI | 1689640948 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50.002138) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 85000637) |
| 363A00000X Physician Assistant (Licence: NC 0010-02841) | |
| Enumeration Date | 2006-02-27 |
| Last Update Date | 2016-11-17 |