| NPI | 1871762740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NH 0770) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH 50-002653) |
| Enumeration Date | 2008-02-26 |
| Last Update Date | 2019-11-05 |