| NPI | 1710967286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50.003476RX) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 0103691) |
| 363AS0400X Physician Assistant, Surgical (Licence: NY 0103691) | |
| Enumeration Date | 2006-01-19 |
| Last Update Date | 2022-01-25 |