| NPI | 1750847166 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50.006993RX) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 0010-08794) |
| 363A00000X Physician Assistant (Licence: NC 0010-08794) | |
| 363A00000X Physician Assistant (Licence: NY 027436) | |
| Enumeration Date | 2019-02-11 |
| Last Update Date | 2023-01-19 |