| NPI | 1689648214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: IN 10001118A) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: OH 50-002861) |
| Enumeration Date | 2006-02-13 |
| Last Update Date | 2016-11-07 |