| NPI | 1821606401 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50.007397RX) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH TT951430) | |
| Enumeration Date | 2020-07-20 |
| Last Update Date | 2025-04-15 |