| NPI | 1780645234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IN 10002018) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: OH 2342) |
| Enumeration Date | 2006-03-31 |
| Last Update Date | 2016-09-26 |