| NPI | 1831348556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50002803) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: OH 50-002803) |
| 363AS0400X Physician Assistant, Surgical (Licence: OH 50.002803) | |
| Enumeration Date | 2008-09-18 |
| Last Update Date | 2019-05-08 |