| NPI | 1841584521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50003788) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MI 1097463) |
| Enumeration Date | 2011-05-31 |
| Last Update Date | 2023-11-03 |