| NPI | 1730832353 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50.007446RX) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 50.007446) |
| Enumeration Date | 2022-02-02 |
| Last Update Date | 2026-01-12 |