| NPI | 1861592743 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: OH 50.002590) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: FL PA9103158) |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2013-08-02 |