| NPI | 1851067565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: OH 50.007864RX) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: OH 50.007864RX) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-08-22 |
| Last Update Date | 2024-06-27 |