| NPI | 1750342382 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: OH 50-001361) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: KY PA2484) |
| 363A00000X Physician Assistant (Licence: OH 50.001361) | |
| Enumeration Date | 2006-03-31 |
| Last Update Date | 2021-09-17 |