| NPI | 1861037277 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50.006232) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ 9556) |
| Enumeration Date | 2019-11-08 |
| Last Update Date | 2023-07-27 |