| NPI | 1770689150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50002487) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: OH 50-002487) |
| Enumeration Date | 2006-09-15 |
| Last Update Date | 2018-07-30 |