| NPI | 1710981543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50.004338) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: OH 5107) |
| Enumeration Date | 2005-06-09 |
| Last Update Date | 2016-01-12 |