| NPI | 1821244856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9114552) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH 50001607) |
| Enumeration Date | 2008-08-11 |
| Last Update Date | 2023-12-06 |