| NPI | 1881700839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA002703L) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH 026980) |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2007-07-08 |