| NPI | 1881371862 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: OH 50.008660RX) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2023-06-30 |
| Last Update Date | 2024-08-09 |