| NPI | 1881285559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50.007934RX) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-11374) |
| Enumeration Date | 2021-01-26 |
| Last Update Date | 2023-03-13 |