| NPI | 1821429895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50.005546RX) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NC 0010-04430) |
| Enumeration Date | 2013-12-02 |
| Last Update Date | 2022-01-25 |