NPI | 1740216555 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50000958) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: OH 50000958) |
Enumeration Date | 2006-06-23 |
Last Update Date | 2024-06-18 |