| NPI | 1689768335 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: SC 1880) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: OH 50.002498) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2022-02-07 |