| NPI | 1881642346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50002399) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: OH 50.002399) |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2022-07-21 |