| NPI | 1710452347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50005733RX) |
| Additional Taxonomies | 207XX0801X Orthopaedic Surgery, Orthopaedic Trauma (Licence: OH 50.005733RX) |
| Enumeration Date | 2018-10-10 |
| Last Update Date | 2018-11-01 |