| NPI | 1821187428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: PA MA001634L) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: OH 50.006516RX) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2020-07-29 |