| NPI | 1871187054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: OH 50.007323RX) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MD C0007882) |
| Enumeration Date | 2021-02-27 |
| Last Update Date | 2022-05-17 |