| NPI | 1760409353 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA00180) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH 51.990223) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2008-02-19 |