| NPI | 1750055695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: OH 50.006917) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2021-08-04 |
| Last Update Date | 2023-11-12 |