NPI | 1821575432 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50.006494RX) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL 9111420) |
Enumeration Date | 2018-07-26 |
Last Update Date | 2023-10-11 |