| NPI | 1700806486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50001394) |
| Additional Taxonomies | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: OH 50.001394) |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2020-11-23 |