| NPI | 1861947335 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50004807RX) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9114246) |
| Enumeration Date | 2016-08-24 |
| Last Update Date | 2025-08-07 |